REHABILITATION COMMITTEEDate____________RecommendedLoanGrant$________forHouseholdSpecial ReliefTransportationHousing__________________Date____________ApprovedLoanGrant$_________for_______________________________Any conditions?Check No.SignedTransportation Request
Above form asillustration
[304]SeeAppendix I,p. 409.
[304]SeeAppendix I,p. 409.
F. W. DOHRMANN,CH.D. O. CROWLEYO. K. CUSHINGJOHN A. EMERYJOHN GALLWEYC. F. LEEGEABRAHAM HAASKATHARINE C. FELTON,SUP.REHABILITATION COMMITTEESAN FRANCISCO RELIEF AND RED CROSS FUNDS(A CORPORATION)GOUGH AND GEARY STREETSThe Rehabilitation Committee, from this time on, will separate its work under two distinct divisions; one established for a limited period and designed to meet the needs of self-supporting families, who cannot, within the means at their command, obtain necessary household furniture or secure homes suitable to live in; the other established on a relief basis, and designed to meet the needs of families who, on account of illness or other misfortune, are for the time being incapable of self-support.Under Division One, applications for housing and household furniture will be considered.(a) HOUSING: The Committee has arranged with several contractors to build four and five roomed cottages, with plumbing installed, at prices ranging from $300 to $800. Any self-supporting man or woman, who is the head of a household, and who, as the result of the disaster, is unable to obtain suitable housing accommodations at rent within his means, can arrange to buy one of these cottages. If he is unable to pay the entire cost, the Committee will make part payment, and when necessary can arrange that the other part may be paid by the purchaser in monthly installments. Not more than $50 in ready money is therefore needed in order to enable any family to take advantage of this offer, and the monthly payment on both house and lot will not exceed the ordinary rent. The Committee is also ready to help those who are building cottages according to their own plans, provided the total cost does not exceed $750. The Committee believes that many families would do well to avail themselves of this offer to obtain a house of their own at small cost. Applications will be received by mail only and should be directed to the “Housing Committee.”(b) HOUSEHOLD FURNITURE. Applications will be received from families who are self-supporting and have suffered material loss from the disaster. The income and present resources must be insufficient to enable the family to get necessary household furniture within a reasonable time, without incurring burdensome debt. No application under this head will be received from anyone to whom the Committee has already made a grant. Applications will be received by mail only. Write for a blank to Gough and Geary streets. Mark envelope “Furniture Application.” No such applications will be received after January 31st, 1907.Division Two is organized on the basis of relief. Applications will be received only from families who, through circumstances beyond their control, are incapable of self-support, and whose applications, even under normal conditions, would be received by any regularly organized relief society. No grants will be made to single persons capable of self-support, to families where the husband is earning practically the same wages as he did before the fire and is capable of supporting those dependent upon him, or to those who have made no plans for the future and who ask for money simply to meet the ordinary every-day expenses.Anyone in need of relief should call at the offices between nine and ten any morning except Saturday. Applications for relief are not received by mail.N. B.—After January 31st [1907], no application will be received under division one except for Housing, and no grant will be made to self-supporting families. This rule will be strictly adhered to.KATHARINE C. FELTONSuperintendent
F. W. DOHRMANN,CH.D. O. CROWLEYO. K. CUSHINGJOHN A. EMERYJOHN GALLWEYC. F. LEEGEABRAHAM HAASKATHARINE C. FELTON,SUP.REHABILITATION COMMITTEESAN FRANCISCO RELIEF AND RED CROSS FUNDS(A CORPORATION)GOUGH AND GEARY STREETSThe Rehabilitation Committee, from this time on, will separate its work under two distinct divisions; one established for a limited period and designed to meet the needs of self-supporting families, who cannot, within the means at their command, obtain necessary household furniture or secure homes suitable to live in; the other established on a relief basis, and designed to meet the needs of families who, on account of illness or other misfortune, are for the time being incapable of self-support.Under Division One, applications for housing and household furniture will be considered.(a) HOUSING: The Committee has arranged with several contractors to build four and five roomed cottages, with plumbing installed, at prices ranging from $300 to $800. Any self-supporting man or woman, who is the head of a household, and who, as the result of the disaster, is unable to obtain suitable housing accommodations at rent within his means, can arrange to buy one of these cottages. If he is unable to pay the entire cost, the Committee will make part payment, and when necessary can arrange that the other part may be paid by the purchaser in monthly installments. Not more than $50 in ready money is therefore needed in order to enable any family to take advantage of this offer, and the monthly payment on both house and lot will not exceed the ordinary rent. The Committee is also ready to help those who are building cottages according to their own plans, provided the total cost does not exceed $750. The Committee believes that many families would do well to avail themselves of this offer to obtain a house of their own at small cost. Applications will be received by mail only and should be directed to the “Housing Committee.”(b) HOUSEHOLD FURNITURE. Applications will be received from families who are self-supporting and have suffered material loss from the disaster. The income and present resources must be insufficient to enable the family to get necessary household furniture within a reasonable time, without incurring burdensome debt. No application under this head will be received from anyone to whom the Committee has already made a grant. Applications will be received by mail only. Write for a blank to Gough and Geary streets. Mark envelope “Furniture Application.” No such applications will be received after January 31st, 1907.Division Two is organized on the basis of relief. Applications will be received only from families who, through circumstances beyond their control, are incapable of self-support, and whose applications, even under normal conditions, would be received by any regularly organized relief society. No grants will be made to single persons capable of self-support, to families where the husband is earning practically the same wages as he did before the fire and is capable of supporting those dependent upon him, or to those who have made no plans for the future and who ask for money simply to meet the ordinary every-day expenses.Anyone in need of relief should call at the offices between nine and ten any morning except Saturday. Applications for relief are not received by mail.N. B.—After January 31st [1907], no application will be received under division one except for Housing, and no grant will be made to self-supporting families. This rule will be strictly adhered to.KATHARINE C. FELTONSuperintendent
F. W. DOHRMANN,CH.D. O. CROWLEYO. K. CUSHINGJOHN A. EMERYJOHN GALLWEYC. F. LEEGEABRAHAM HAASKATHARINE C. FELTON,SUP.REHABILITATION COMMITTEESAN FRANCISCO RELIEF AND RED CROSS FUNDS(A CORPORATION)GOUGH AND GEARY STREETS
F. W. DOHRMANN,CH.D. O. CROWLEYO. K. CUSHINGJOHN A. EMERYJOHN GALLWEYC. F. LEEGEABRAHAM HAASKATHARINE C. FELTON,SUP.
F. W. DOHRMANN,CH.D. O. CROWLEYO. K. CUSHINGJOHN A. EMERYJOHN GALLWEYC. F. LEEGEABRAHAM HAAS
F. W. DOHRMANN,CH.D. O. CROWLEYO. K. CUSHINGJOHN A. EMERYJOHN GALLWEYC. F. LEEGEABRAHAM HAAS
KATHARINE C. FELTON,SUP.
REHABILITATION COMMITTEESAN FRANCISCO RELIEF AND RED CROSS FUNDS(A CORPORATION)GOUGH AND GEARY STREETS
REHABILITATION COMMITTEE
SAN FRANCISCO RELIEF AND RED CROSS FUNDS(A CORPORATION)
GOUGH AND GEARY STREETS
The Rehabilitation Committee, from this time on, will separate its work under two distinct divisions; one established for a limited period and designed to meet the needs of self-supporting families, who cannot, within the means at their command, obtain necessary household furniture or secure homes suitable to live in; the other established on a relief basis, and designed to meet the needs of families who, on account of illness or other misfortune, are for the time being incapable of self-support.
Under Division One, applications for housing and household furniture will be considered.
(a) HOUSING: The Committee has arranged with several contractors to build four and five roomed cottages, with plumbing installed, at prices ranging from $300 to $800. Any self-supporting man or woman, who is the head of a household, and who, as the result of the disaster, is unable to obtain suitable housing accommodations at rent within his means, can arrange to buy one of these cottages. If he is unable to pay the entire cost, the Committee will make part payment, and when necessary can arrange that the other part may be paid by the purchaser in monthly installments. Not more than $50 in ready money is therefore needed in order to enable any family to take advantage of this offer, and the monthly payment on both house and lot will not exceed the ordinary rent. The Committee is also ready to help those who are building cottages according to their own plans, provided the total cost does not exceed $750. The Committee believes that many families would do well to avail themselves of this offer to obtain a house of their own at small cost. Applications will be received by mail only and should be directed to the “Housing Committee.”
(b) HOUSEHOLD FURNITURE. Applications will be received from families who are self-supporting and have suffered material loss from the disaster. The income and present resources must be insufficient to enable the family to get necessary household furniture within a reasonable time, without incurring burdensome debt. No application under this head will be received from anyone to whom the Committee has already made a grant. Applications will be received by mail only. Write for a blank to Gough and Geary streets. Mark envelope “Furniture Application.” No such applications will be received after January 31st, 1907.
Division Two is organized on the basis of relief. Applications will be received only from families who, through circumstances beyond their control, are incapable of self-support, and whose applications, even under normal conditions, would be received by any regularly organized relief society. No grants will be made to single persons capable of self-support, to families where the husband is earning practically the same wages as he did before the fire and is capable of supporting those dependent upon him, or to those who have made no plans for the future and who ask for money simply to meet the ordinary every-day expenses.
Anyone in need of relief should call at the offices between nine and ten any morning except Saturday. Applications for relief are not received by mail.
N. B.—After January 31st [1907], no application will be received under division one except for Housing, and no grant will be made to self-supporting families. This rule will be strictly adhered to.
KATHARINE C. FELTONSuperintendent
No.REHABILITATION COMMITTEESan Francisco Relief and Red Cross Funds, Inc.Dated1907SurnameDateAddressRoomsRentApril 17thHow long?First NameAgeOccupa-tionEarnings Per WeekPhysical conditionNameAddressof EmployerManWomanChildrenOthers in FamilyOther ReferencesInsurance: Amount?Savings: Amount?What companies?Real Estate: Value?Other Property?Attachtwo letters of reference. If possible one should be from a former landlord to whom you have paid rent for some time. If you are living in a permanent camp, one letter must be from the Camp Commander.(OVER)
No.REHABILITATION COMMITTEESan Francisco Relief and Red Cross Funds, Inc.Dated1907SurnameDateAddressRoomsRentApril 17thHow long?First NameAgeOccupa-tionEarnings Per WeekPhysical conditionNameAddressof EmployerManWomanChildrenOthers in FamilyOther ReferencesInsurance: Amount?Savings: Amount?What companies?Real Estate: Value?Other Property?Attachtwo letters of reference. If possible one should be from a former landlord to whom you have paid rent for some time. If you are living in a permanent camp, one letter must be from the Camp Commander.(OVER)
Above form asillustration
[305]On the reverse side space was provided for answers to the following:What sum do you ask from the Rehabilitation Committee?State clearly the use to which you wish to put this moneyState clearly what have been the circumstances that make this application necessary
[305]On the reverse side space was provided for answers to the following:
F. W. Dohrmann,ChairmanD. O. CROWLEYO. K. CUSHINGJOHN A. EMERYJOHN GALLWEYABRAHAM HAASC. F. LEEGEKATHERINE C. FELTONSuperintendentREHABILITATION COMMITTEESAN FRANCISCO RELIEF ANDRED CROSS FUNDSA CORPORATIONGOUGH AND GEARY STS.SPECIAL COMMITTEEON HOUSING ANDSHELTERREV. D. O. CROWLEY,ChairmanMISS A. GRIFFITHDR. A. A. D’ANCONAMR. JOSEPH C. QUEENMR.O.ALBERT BERNARDletterheadSan Francisco,Dearhasmade application to avail himself of the offer of this Committee to assist in the refurnishing of homes, an offer which you have probably seen in the daily papers, and has given your name to us as his principal reference.In sending you this letter, the Rehabilitation Committee urges you to consider that the great majority of those who apply for relief are strangers to the Committee, and that it cannot deal with their applications either justly or quickly unless those who do know them are willing to consider themselves as in a sense trustees of this fund, and to share with the Committee some of the responsibility of its administration.In this present investigation, the Rehabilitation Committee expects to rely largely upon the information it receives from the references of applicants, and therefore deems it especially important to emphasize at this time its need for accurate and full information. Anything that is written is regarded as entirely confidential.O. K. CUSHING,Acting Chairman.QUESTIONSHow long has Mr. .......... been in your employ? ..........Wages per week at present? ..........Is the work likely to be permanent? ..........Are you in a position to state whether this applicant is temperate, honest, and of good character? ..........Can you freely recommend the granting of this application? ..........N. B.—Send reply in enclosed directed envelope.
F. W. Dohrmann,ChairmanD. O. CROWLEYO. K. CUSHINGJOHN A. EMERYJOHN GALLWEYABRAHAM HAASC. F. LEEGEKATHERINE C. FELTONSuperintendentREHABILITATION COMMITTEESAN FRANCISCO RELIEF ANDRED CROSS FUNDSA CORPORATIONGOUGH AND GEARY STS.SPECIAL COMMITTEEON HOUSING ANDSHELTERREV. D. O. CROWLEY,ChairmanMISS A. GRIFFITHDR. A. A. D’ANCONAMR. JOSEPH C. QUEENMR.O.ALBERT BERNARD
F. W. Dohrmann,ChairmanD. O. CROWLEYO. K. CUSHINGJOHN A. EMERYJOHN GALLWEYABRAHAM HAASC. F. LEEGEKATHERINE C. FELTONSuperintendentREHABILITATION COMMITTEESAN FRANCISCO RELIEF ANDRED CROSS FUNDSA CORPORATIONGOUGH AND GEARY STS.SPECIAL COMMITTEEON HOUSING ANDSHELTERREV. D. O. CROWLEY,ChairmanMISS A. GRIFFITHDR. A. A. D’ANCONAMR. JOSEPH C. QUEENMR.O.ALBERT BERNARD
F. W. Dohrmann,ChairmanD. O. CROWLEYO. K. CUSHINGJOHN A. EMERYJOHN GALLWEYABRAHAM HAASC. F. LEEGEKATHERINE C. FELTONSuperintendentREHABILITATION COMMITTEESAN FRANCISCO RELIEF ANDRED CROSS FUNDSA CORPORATIONGOUGH AND GEARY STS.
F. W. Dohrmann,ChairmanD. O. CROWLEYO. K. CUSHINGJOHN A. EMERYJOHN GALLWEYABRAHAM HAASC. F. LEEGEKATHERINE C. FELTONSuperintendentREHABILITATION COMMITTEESAN FRANCISCO RELIEF ANDRED CROSS FUNDSA CORPORATIONGOUGH AND GEARY STS.
F. W. Dohrmann,ChairmanD. O. CROWLEYO. K. CUSHINGJOHN A. EMERYJOHN GALLWEYABRAHAM HAASC. F. LEEGEKATHERINE C. FELTONSuperintendent
F. W. Dohrmann,
Chairman
D. O. CROWLEY
O. K. CUSHING
JOHN A. EMERY
JOHN GALLWEY
ABRAHAM HAAS
C. F. LEEGE
KATHERINE C. FELTON
Superintendent
REHABILITATION COMMITTEESAN FRANCISCO RELIEF ANDRED CROSS FUNDSA CORPORATIONGOUGH AND GEARY STS.
REHABILITATION COMMITTEE
SAN FRANCISCO RELIEF ANDRED CROSS FUNDS
A CORPORATION
GOUGH AND GEARY STS.
SPECIAL COMMITTEEON HOUSING ANDSHELTERREV. D. O. CROWLEY,ChairmanMISS A. GRIFFITHDR. A. A. D’ANCONAMR. JOSEPH C. QUEENMR.O.ALBERT BERNARD
SPECIAL COMMITTEEON HOUSING ANDSHELTER
REV. D. O. CROWLEY,
Chairman
MISS A. GRIFFITH
DR. A. A. D’ANCONA
MR. JOSEPH C. QUEEN
MR.O.ALBERT BERNARD
letterhead
letterhead
San Francisco,Dearhasmade application to avail himself of the offer of this Committee to assist in the refurnishing of homes, an offer which you have probably seen in the daily papers, and has given your name to us as his principal reference.In sending you this letter, the Rehabilitation Committee urges you to consider that the great majority of those who apply for relief are strangers to the Committee, and that it cannot deal with their applications either justly or quickly unless those who do know them are willing to consider themselves as in a sense trustees of this fund, and to share with the Committee some of the responsibility of its administration.In this present investigation, the Rehabilitation Committee expects to rely largely upon the information it receives from the references of applicants, and therefore deems it especially important to emphasize at this time its need for accurate and full information. Anything that is written is regarded as entirely confidential.O. K. CUSHING,Acting Chairman.QUESTIONSHow long has Mr. .......... been in your employ? ..........Wages per week at present? ..........Is the work likely to be permanent? ..........Are you in a position to state whether this applicant is temperate, honest, and of good character? ..........Can you freely recommend the granting of this application? ..........N. B.—Send reply in enclosed directed envelope.
San Francisco,
Dear
hasmade application to avail himself of the offer of this Committee to assist in the refurnishing of homes, an offer which you have probably seen in the daily papers, and has given your name to us as his principal reference.
In sending you this letter, the Rehabilitation Committee urges you to consider that the great majority of those who apply for relief are strangers to the Committee, and that it cannot deal with their applications either justly or quickly unless those who do know them are willing to consider themselves as in a sense trustees of this fund, and to share with the Committee some of the responsibility of its administration.
In this present investigation, the Rehabilitation Committee expects to rely largely upon the information it receives from the references of applicants, and therefore deems it especially important to emphasize at this time its need for accurate and full information. Anything that is written is regarded as entirely confidential.
O. K. CUSHING,Acting Chairman.
QUESTIONS
How long has Mr. .......... been in your employ? ..........
Wages per week at present? ..........
Is the work likely to be permanent? ..........
Are you in a position to state whether this applicant is temperate, honest, and of good character? ..........
Can you freely recommend the granting of this application? ..........
N. B.—Send reply in enclosed directed envelope.
FORM FOR SPECIAL RELIEFIn duplicate, both copies to be forwarded to the Executive Officer. Issues to be made only to women and children in need; men only when sick and destitute. Following questions must be answered in every case.CAMPDATE1907SUPERINTENDENT OF SPECIAL RELIEF,SIR:I HAVE RECOMMENDED THAT THE FOLLOWING BE SUPPLIED:Name of Applicant in full and AgeWagesFull Name of Parents or Husband or WifeIf not Working, why?Present AddressMeans of SupportAddress Prior to April 18th, 1906Number in FamilyOccupationRelief Already Received from the Rehabilitation CommitteeARTICLESApproved:Approved:Executive OfficerCamp Commander
FORM FOR SPECIAL RELIEFIn duplicate, both copies to be forwarded to the Executive Officer. Issues to be made only to women and children in need; men only when sick and destitute. Following questions must be answered in every case.CAMPDATE1907SUPERINTENDENT OF SPECIAL RELIEF,SIR:I HAVE RECOMMENDED THAT THE FOLLOWING BE SUPPLIED:Name of Applicant in full and AgeWagesFull Name of Parents or Husband or WifeIf not Working, why?Present AddressMeans of SupportAddress Prior to April 18th, 1906Number in FamilyOccupationRelief Already Received from the Rehabilitation CommitteeARTICLESApproved:Approved:Executive OfficerCamp Commander
Above form asillustration
BUREAU OF SPECIAL RELIEFHERBERT GUNN, M. D.Supt. Bureau Special ReliefDepartment of Relief and RehabilitationSan Francisco Relief and Red Cross FundsGEARY AND GOUGH STREETSWeek Ending190REPORT OF SECTIONNO. ORDERS ISSUEDNEWNO. ORDERS ISSUEDREPEATTOTALNO. ORDERS DISCONTINUEDAre orders filled promptly and are articles of good quality?(SIGNED)
BUREAU OF SPECIAL RELIEFHERBERT GUNN, M. D.Supt. Bureau Special ReliefDepartment of Relief and RehabilitationSan Francisco Relief and Red Cross FundsGEARY AND GOUGH STREETSWeek Ending190REPORT OF SECTIONNO. ORDERS ISSUEDNEWNO. ORDERS ISSUEDREPEATTOTALNO. ORDERS DISCONTINUEDAre orders filled promptly and are articles of good quality?(SIGNED)
Above form asillustration
Nº 1102HERBERT GUNN, M. D.Supt. Bureau Special ReliefBUREAU OF SPECIAL RELIEFGeary and Gough StreetsSan Francisco,1906SectionPlease call onAddressRelief requiredRemarksKindly return this paper with your report.Reported by letter or in personRefer to
Nº 1102HERBERT GUNN, M. D.Supt. Bureau Special ReliefBUREAU OF SPECIAL RELIEFGeary and Gough StreetsSan Francisco,1906SectionPlease call onAddressRelief requiredRemarksKindly return this paper with your report.Reported by letter or in personRefer to
Above form asillustration
[306]Printed with duplicate on yellow paper beneath for carbon copy.
[306]Printed with duplicate on yellow paper beneath for carbon copy.
DateORIGINALREPEATBUREAU OF SPECIAL RELIEFORIGINALORDERNo.DateSurnameFirst Name:Man’sWoman’sAddressAddress April 18, 1906?Number in family?AgesAdult Males?AgesAdult Females?AgesNameOccupationWhere EmployedAmount per WeekAmt. Recd. from Rehab. Com. $DateHow expended?Insurance?Companies?Savings Amount?Bank:Real Estate:Value:Location:Other resources:Residence Continuous in S. F. since April 18th?Will require relief for:Reason for requiring relief:Physician attending?Paid?Articles required:Meat OrderApproved
DateORIGINALREPEATBUREAU OF SPECIAL RELIEFORIGINALORDERNo.DateSurnameFirst Name:Man’sWoman’sAddressAddress April 18, 1906?Number in family?AgesAdult Males?AgesAdult Females?AgesNameOccupationWhere EmployedAmount per WeekAmt. Recd. from Rehab. Com. $DateHow expended?Insurance?Companies?Savings Amount?Bank:Real Estate:Value:Location:Other resources:Residence Continuous in S. F. since April 18th?Will require relief for:Reason for requiring relief:Physician attending?Paid?Articles required:Meat OrderApproved
Above form asillustration
[307]Printed with duplicates on yellow paper for carbon copies.
[307]Printed with duplicates on yellow paper for carbon copies.
BUREAU OF SPECIAL RELIEFDepartment of Relief and RehabilitationSan Francisco Relief and Red Cross FundsGEARY AND GOUGH STREETSSan Francisco,190NameAddressDear Sirs:Please deliver tothe following articlesand charge to Bureau of Special Relief.CostCostApples (dry),Potatoes,Beans,Prunes,Bread,Rice,Butter,Salt,Cocoa,Soap,Coffee,Sago,Condensed Milk,Sugar,Eggs,Tea,Flour,Pepper,Macaroni,Candles,Mush,TotalTotalReceived above articlesSuperintendent.IF UNABLE TO DELIVER, NOTIFY THIS OFFICE AT ONCE
BUREAU OF SPECIAL RELIEFDepartment of Relief and RehabilitationSan Francisco Relief and Red Cross FundsGEARY AND GOUGH STREETSSan Francisco,190NameAddressDear Sirs:Please deliver tothe following articlesand charge to Bureau of Special Relief.CostCostApples (dry),Potatoes,Beans,Prunes,Bread,Rice,Butter,Salt,Cocoa,Soap,Coffee,Sago,Condensed Milk,Sugar,Eggs,Tea,Flour,Pepper,Macaroni,Candles,Mush,TotalTotalReceived above articlesSuperintendent.IF UNABLE TO DELIVER, NOTIFY THIS OFFICE AT ONCE
Above form asillustration
Actual size of sheet 16 x 21 inches.
Above form asillustration
[FORM A—GENERAL STATEMENT. FACE]Ap. No.APPLICATION FOR BUSINESS REHABILITATION1.Full nameAge2.Present residence3.Residence prior to April 18, 19064.Present occupation and place of employment5.Physical condition6.Nature of business to be re-established7.How long in this business?8.Location of business on April 18, 19069.How long at above address?10.Prior address11.Has location for re-establishment of the business been secured?12.If so, where, and under what conditions?13.If no location has been secured, what is the outlook for a definite and permanentlocation?14.Statement of losses:Amount.Where?Amount.Where?a.Storef.Housesb.Officeg.Furniturec.Fixturesh.Clothingd.Stocki.Misc. (household)e.Misc. (business)15.On which of above has insurance been collected, and how much?16.Statement of resources:Insurance uncollected, $In what companies?Savings, $Which bank, or where?Real estate, $LocationStock, etc., on hand at presentWhere?
[FORM A—GENERAL STATEMENT. FACE]Ap. No.APPLICATION FOR BUSINESS REHABILITATION1.Full nameAge2.Present residence3.Residence prior to April 18, 19064.Present occupation and place of employment5.Physical condition6.Nature of business to be re-established7.How long in this business?8.Location of business on April 18, 19069.How long at above address?10.Prior address11.Has location for re-establishment of the business been secured?12.If so, where, and under what conditions?13.If no location has been secured, what is the outlook for a definite and permanentlocation?14.Statement of losses:Amount.Where?Amount.Where?a.Storef.Housesb.Officeg.Furniturec.Fixturesh.Clothingd.Stocki.Misc. (household)e.Misc. (business)15.On which of above has insurance been collected, and how much?16.Statement of resources:Insurance uncollected, $In what companies?Savings, $Which bank, or where?Real estate, $LocationStock, etc., on hand at presentWhere?
Above form asillustration